1. Field of the Invention
The present invention pertains to suturing of bodily tissue and, more particularly, to methods, apparatus and systems for suturing tissue during endoscopic procedures.
2. Discussion of the Prior Art
Suturing of bodily tissue is a time consuming part of most surgical procedures including both open surgery and endoscopic or closed surgery. By open surgery is meant surgery wherein the surgeon gains access to the surgical site via a relatively large incision, and by endoscopic surgery is meant surgery wherein the surgeon gains access to the surgical site via one or more portals through which endoscopes are introduced to view the surgical site and through which various instruments are introduced to the surgical site. There are many common endoscopic surgical procedures, including arthroscopy, laparoscopy (pelviscopy), gastroentroscopy and laryngobronchoscopy, for example. In the past, suturing has been accomplished with the use of a sharp metal suture needle attached to the end of a length of suture material, the suture needle being caused to penetrate and pass through the tissue pulling the suture material through the tissue. Once the suture material has been pulled through the tissue, the surgeon ties a knot in the suture material, the knotting procedure allowing the surgeon to adjust the tension on the suture material to accommodate the particular tissue being sutured and control approximation, occlusion, attachment or other conditions of the tissue. The ability to control tension is extremely important to the surgeon regardless of the type of surgical procedure being performed; however, knotting of the suture material is time consuming and tedious work, particularly in microsurgery and endoscopic surgery. In microsurgery, suturing is necessarily time consuming due to the small size of the suture needle and the suture material and the concomitant difficult manipulation required to pass the suture needle through the tissue and to tie a knot in the suture material. With respect to endoscopic surgery, suturing and tying knots represents an even more time consuming procedure due to the difficult maneuvers required. Accordingly, while endoscopic surgery would be preferred for most procedures, the advantages are often outweighed by the disadvantages caused by the length of time required to complete the endoscopic surgical procedure, which time is greatly extended due to the time required for suturing.
There have been many attempts to provide devices to take the place of conventional suturing with a suture needle and a length of suture material; however, such prior art devices have essentially been staples, clips or clamps not allowing any adjustment of tension by the surgeon. French Patent No. 2,651,113 to Alain and U.S. Pat. Nos. 3,123,077 to Alcamo, No. 3,570,497 to Lemole, No. 4,548,202 to Duncan, No. 4,592,355 to Antebi, No. 4,730,615 to Sutherland et al, No. 4,935,028 to Drews, No. 4,950,285 to Wilk, No. 4,955,913 to Robinson and No. 5,123,913 to Wilk are representative of prior art devices for use during open surgery to adjustably hold tissue together similar to suturing and tying but fail to provide the same feel and tension control as knotting a length of suture material. U.S. Pat. No. 3,910,281 to Kletschka et al is representative of suture anchors for facilitating tying.
Endoscopic surgery is preferred over open surgery due to the greatly reduced trauma and wound healing time for the patient and due to concomitant cost savings associated with shorter hospital stays and performing surgery without general anesthesia and in non-hospital or out-patient surgery sites. Accordingly, there has been much effort spent to develop techniques for facilitating the suturing normally performed by use of a suture needle and a length of suture material. Alternative techniques proposed have included electrical coagulation, mechanical devices such as clips, clamps and staples, and lasers; however, no well accepted alternative has yet been found in that suturing and tying are essential and vital parts of most surgical procedures. That is, to date the proposed alternatives have had disadvantages, including increased risk to the patient, while not providing the surgeon with the advantages of suturing and tying and not being useful in a wide range of procedures to allow expansion of the areas in which endoscopic surgery can be effectively performed. Thus, there is a great need for suturing techniques useful in endoscopic surgery to permit surgeons to suture with controlled tension and approximation of tissue similar to that obtained by conventional knot tying.
U.S. Pat. No. 3,775,825 to Wood et al discloses apparatus and method for suturing wherein clips are secured on the free ends of a suture filament; however, the apparatus and method are not practical for endoscopic procedures.
U.S. Pat. Nos. 5,078,731 to Hayhurst and No. 5,171,251 to Bregen et al are representative of clips for clamping suture material to eliminate knotting during endoscopic procedures. European Patent Publication No. 0,477,020A to Chen et al and U.S. Pat. Nos. 5,015,250 to Foster, No. 5,037,433 to Wilk et al, No. 5,059,201 to Asnis, No. 5,084,058 to Li, No. 5,087,263 to Li, No. 5,100,415 to Hayhurst, No. 5,100,421 to Christoudias, No. 5,144,961 to Chen, No. 5,147,373 to Ferzli, No. 5,152,769 to Baber and No. 5,163,946 to Li are representative of needle holders and apparatus for suturing, knotting or ligating during endoscopic procedures which, however, have the disadvantages of requiring complex instruments, of requiring special suture devices, of being difficult to manipulate and/or of not sufficiently reducing the time required for suturing.
U.S. Pat. Nos. 4,932,962, No. 4,981,149 and No. 5,074,874 to Yoon et al and U.S. Pat. Nos. 4,935,027, No. 5,053,047 and No. 5,100,418 to Yoon disclose methods and apparatus particularly useful for suturing during endoscopic procedures to permit tissue approximation with controlled tension.